La infección congénita por citomegalovirus, ¿es más prevalente en nuestro medio en neonatos expuestos al VIH? / Congenital cytomegalovirus infection, is more prevalent in our country in newborns exposed to HIV?

Objetivos. La infección congénita por citomegalovirus (CMVc) se ha considerado más prevalente en hijos de madre infectadas por VIH (RNEVIH). Por ello, las guías nacionales aconsejan el cribado del CMVc en el RNEVIH. Actualmente estas gestantes en España presentan mejor control de la infección que en décadas precedentes, pudiendo afectar a dicha prevalencia. El objetivo del estudio es analizar la prevalencia y posibles factores de riesgo asociados a la CMVc en RNEVIH en la era del tratamiento antirretroviral combinado (TAR). Pacientes y métodos. Estudio transversal retrospectivo, incluyendo todos los hijos de madre con VIH nacidos en un hospital de tercer nivel (2014-2020). Se recogieron datos epidemiológicos y clínicos de la madre y del neonato. Se realizó cribado neonatal de CMV con cultivo de orina shell vial y/o PCR en las 2 primeras semanas de vida. Resultados. Se incluyeron 69 neonatos. El 82,4% de las madres habían sido diagnosticadas de VIH previamente al embarazo. Todas recibieron TAR durante la gestación. La mediana de linfocitos T-CD4 previos al parto fue 641/mm3 (RIC: 480-865) y la CV fue indetectable en el 83,6%. La serología para CMV en el primer trimestre se realizó en el 73,5% (IgG positiva en el 96%). No hubo casos de transmisión vertical de VIH ni CMVc (IC 95%: 0-5,3%). Conclusiones. La prevalencia de CMVc en neonatos expuestos al VIH en nuestra cohorte fue del 0%, inferior a la documentada en estudios previos, posiblemente en relación con el acceso precoz al TAR en las gestantes y su buena situación inmunológica. (AU)

Objectives. Congenital cytomegalovirus infection (cCMV) has been considered more prevalent among HIV-exposed children during pregnancy. Spanish national guidelines recommend the cCMV screening in these newborns. Nowadays, pregnant women have a better control of HIV infection compared to previous decades. We aim to analyze the prevalence and associated risk factors to cCMV in these children. Patients and methods. A retrospective cross-sectorial study was performed. All newborns exposed to HIV were assisted in a third-level hospital (2014-2020). Epidemiological and clinical data of the mother and newborn were recorded. Shell vial urine culture and/or CRP were performed along the two first weeks of life for the neonatal screening of cCMV. Results. Overall 69 newborns were enrolled. A high proportion (82.4%) of the mothers had been diagnosed with HIV before getting pregnant. All women received ART during the pregnancy. Median T-CD4 lymphocytes before delivery was 641/mm3 (IQR: 480-865) and the viral load was undetectable in 83.6%. Serological test for CMV along the first trimester of pregnancy was performed in 73.5% (positive IgG in 96%). There were no congenital cases of HIV neither cCMV (CI 95%:0-5.3%). Conclusions. The cCMV prevalence in newborns exposed to HIV was 0%, lower than reported before, probably related to a better and earlier ART during pregnancy, leading to a better immunological status. (AU)

West Syndrome in Children With Congenital Zika Virus Infection.

Congenital Zika infection has been linked with a characteristic phenotype including neurologic sequelae. However, West syndrome has not been previously well described as a consequence. We aim to show this association through a retrospective descriptive study performed in Ecuador. Among 147 infants with congenital Zika infection, 7.5% suffered from West syndrome. Vigabatrin seems to be effective to control the spasms.

Long-Term Outcomes of Infants with Congenital Zika Virus Infection in Ecuador: A Retrospective Longitudinal Study.

BACKGROUND: Few congenital Zika syndrome (CZS) cases have been notified in Ecuador and, to our knowledge, there are no significant published studies dealing with their clinical evolution. We present a detailed clinical characterization of 21 children with congenital Zika virus (ZIKV) infection born in Ecuador who were followed up until September 2019. METHODS: We did a retrospective longitudinal study of children attended by the infectious disease specialists of Francisco Icaza Bustamante Children's Hospital (Guayaquil) due to congenital ZIKV infection suspicion. The inclusion criteria consisted of laboratory confirmed diagnosis of congenital ZIKV infection. RESULTS: Sixteen of these 21 cases of congenital ZIKV infection showed clinical, neuroimaging and laboratory findings strongly suggestive of CZS and 5 children showed laboratory findings compatible with congenital ZIKV infection without congenital manifestations associated to CZS. All children with CZS showed neurodevelopmental delay, spasticity and hyperreflexia during follow-up, whereas the majority of them (14/15) experienced recurrent epileptic seizures and dysphagia (12/13). Two CZS cases died during follow-up. Visual evoked potential and hearing screening with acoustically evoked auditory brainstem response were abnormal in 50% and 37.5% of CZS cases, respectively. Congenital ZIKV infection without findings consistent with CZS at birth was not clinically relevant at 23 months of age in the five cases of our cohort. CONCLUSIONS: Severe neurodevelopmental delay, severe microcephaly, epileptic seizures and dysphagia were present at 2 years of age in most CZS cases of our cohort.

[Neutropenia associated with the use of cefepime in pediatric patients with cystic fibrosis]. / Neutropenia asociada al uso de cefepime en pacientes pediátricos con fibrosis quística.

Pulmonary exacerbations of infectious cause are one of the major complications in patients with cystic fibrosis (CF). These are associated with a progressive increase in morbidity and mortality. The treatment depending on the isolated microorganism. The ß-lactam antibiotics are generally used which are not exempt from adverse reactions. Next, two report of neutropenia cases are described after prolonged use of cefepime in CF patients.

Neutropenia asociada al uso de cefepime en pacientes pediátricos con fibrosis quística / Neutropenia associated with the use of cefepime in pediatric patients with cystic fibrosis

Resumen Las exacerbaciones pulmonares de causa infecciosa son una de las mayores complicaciones en los pacientes con fibrosis quística (FQ). Estas se asocian a un progresivo aumento en la morbilidad y mortalidad. El tratamiento antimicrobiano se realiza dependiendo del microorganismo aislado. Con frecuencia se utilizan antimicrobianos β-lactámicos, los cuales no están exentos de reacciones adversas. A continuación, se describen dos casos de neutropenia tras el uso prolongado de cefepime en pacientes con FQ.

Pulmonary exacerbations of infectious cause are one of the major complications in patients with cystic fibrosis (CF). These are associated with a progressive increase in morbidity and mortality. The treatment depending on the isolated microorganism. The β-lactam antibiotics are generally used which are not exempt from adverse reactions. Next, two report of neutropenia cases are described after prolonged use of cefepime in CF patients.

Consenso de farmacia clínica intensiva a nivel nacional / Consensus about the duties of pharmacists in intensive care units in Chile

In 2015, the directors of the Clinical Pharmacists Division of the Chilean Society of Intensive Care Medicine (SOCHIMI) organized a collaborative work along the country to define the minimum activities and duties that a pharmacist should perform in an Intensive Care Unit in Chile, according to the Ministry of Health and SOCHIMI guidelines and recommendations. This document summarizes the agreements on three priority areas of pharmacists' duties in intensive care: a) pharmacotherapy follow-up; b) pharmacological surveillance and security management of medications, and c) data recording and documentation. The recommendations collect the experiences from Chilean pharmacists along the country and provide information and support for future consensus for other specialties.

[Consensus about the duties of pharmacists in intensive care units in Chile]. / Consenso de farmacia clínica intensiva a nivel nacional.

In 2015, the directors of the Clinical Pharmacists Division of the Chilean Society of Intensive Care Medicine (SOCHIMI) organized a collaborative work along the country to define the minimum activities and duties that a pharmacist should perform in an Intensive Care Unit in Chile, according to the Ministry of Health and SOCHIMI guidelines and recommendations. This document summarizes the agreements on three priority areas of pharmacists' duties in intensive care: a) pharmacotherapy follow-up; b) pharmacological surveillance and security management of medications, and c) data recording and documentation. The recommendations collect the experiences from Chilean pharmacists along the country and provide information and support for future consensus for other specialties.

Vacunación frente a Bordetella pertussis en embarazadas. ¿Es adecuada nuestra estrategia de vacunación? / Immunization of pregnant women against pertussis. Are we using the best approach?

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The Intra-Americas Sea low-level jet: overview and future research.

A relevant climate feature of the Intra-Americas Sea (IAS) is the low-level jet (IALLJ) dominating the IAS circulation, both in summer and winter; and yet it is practically unknown with regard to its nature, structure, interactions with mid-latitude and tropical phenomena, and its role in regional weather and climate. This paper updates IALLJ current knowledge and its contribution to IAS circulation-precipitation patterns and presents recent findings about the IALLJ based on first in situ observations during Phase 3 of the Experimento Climático en las Albercas de Agua Cálida (ECAC), an international field campaign to study IALLJ dynamics during July 2001. Nonhydrostatic fifth-generation Pennsylvania State University National Center for Atmospheric Research Mesoscale Model (MM5) simulations were compared with observations and reanalysis. Large-scale circulation patterns of the IALLJ northern hemisphere summer and winter components suggest that trades, and so the IALLJ, are responding to land-ocean thermal contrasts during the summer season of each continent. The IALLJ is a natural component of the American monsoons as a result of the continent's approximate north-south land distribution. During warm (cold) El Niño-Southern Oscillation phases, winds associated with the IALLJ core (IALLJC) are stronger (weaker) than normal, so precipitation anomalies are positive (negative) in the western Caribbean near Central America and negative (positive) in the central IAS. During the ECAC Phase 3, strong surface winds associated with the IALLJ induced upwelling, cooling down the sea surface temperature by 1-2 degrees C. The atmospheric mixed layer height reached 1 km near the surface wind maximum below the IALLJC. Observations indicate that primary water vapor advection takes place in a shallow layer between the IALLJC and the ocean surface. Latent heat flux peaked below the IALLJC. Neither the reanalysis nor MM5 captured the observed thermodynamic and kinematic IALLJ structure. So far, IALLJ knowledge is based on either dynamically initialized data or simulations of global (regional) models, which implies that a more systematic and scientific approach is needed to improve it. The Intra-Americas Study of Climate Processes is a great regional opportunity to address trough field work, modeling, and process studies, many of the IALLJ unknown features.

Prevalencia de la angiostrongilosis abdominal y la distribución estacional de la precipitación / Prevalence of the abdominal angiostrongyliasis and the distribution seasonal of the precipitation

Se hace una breve descripción de la Angiostrongylosis Abdominal (AA), una enfermedad parasitaria caracterizada por una reacción inflamatoria granulomatosa con fuerte infiltración eosinofílica de la pared intestinal, especialmente en la región ileocecoapendicular. Se resumen aspectos de la enfermedad relacionados con su etiología, epidemiología, patología, manifestaciones clínicas, diagnóstico y tratamiento. Se presenta un estudio preliminar de la relación entre prevalencia de AA y el promedio y la distribución estacional de la precipitación en dos regiones de Costa Rica en el período1994 - 1996. A pesar de que el período analizado es relativamente corto y hay otros factores biológicos, ecológicos y humanos que afectan el comportamiento de AA, la distribución estacional de precipitación parece jugar un papel importante en su prevalencia; posiblemente, facilitando la necesaria y continua humedad para el desarrollo de los huéspedes intermediarios del parásito.

El niño - oscilación del sur y algunas series de temperatura máxima y brillo solar en Costa Rica

Se analizan algunas de las características de "El niño-oscilación sel Sur (ENOS) y su posible relación con la distribución espacial y temporal de las anomalías de valores meensuales de temperatura máxima y brillo solar, para algunas regiones seleccionadas en Costa Rica. Las series son primero desestacionalizadas en Costa Rica. Las series son primero desestacionalizadas y luego suavizadas para disminuir la contribuci:n de componentes de período menor que un año aproximadamente. En este priocedimiento se usan las técnicas de promedios móviles y el análisis de Fourier. En especial, las series de temperatura muestran fluctuaciones del orden de 0.5o a 10C que podrían estar asociados al fenómeno ENOS. El brillo solar muestra alguna consistencia con los resultados de la temperatura máxima, sin embargo su comportamiento es más dificil de ser interpretado. En casi todas las estaciones analizadas, la temperatura muestra una tendencia positiva del orden de 0.5oC en las últimas dos décadas, consistente con la idea de un calentamiento regional (AU)

La oscilación cuasi - bienal, ENOS y acoplamiento de algunos parámetros superficiales y estratosféricos sobre Costa Rica

La ascilación cuasi-bienal (OCB) sobre Costa Rica se identifica claramente en la componentezonal del viento en 50 hPa con un período dominante de cerca de 29 meses. Las faces del este de la OCB parecen estar relacionadas en forma alterna con la componente cálida ENOS> La presión atmósferica en superficie muestra una buena consistencia con las fases del este de la OCB y con resultados anteriores de los autores para las anomalias desestacionalizadas de la temperatura máxima para varias zonas del país durante episodios. El niño. Se aprecia un gradiente mayor de presión Atlántico-Pacíficvo durante eventos cálidos ENOS en comparación, con eventos frios, lo que podría estar asociado al aumento observado de la velocidad de los alisios en el país. El ozono total para Costa Rica es analizado para un período relativamente corto (1978-1988) pero muestyra aspectos coherentes con los resultados anteriores (AU)